| NPI | 1528218047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX P1437) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME111564) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX as4628395) | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2022-01-26 |