| NPI | 1578949830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 55677) |
| Additional Taxonomies | 174400000X Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-09 |
| Last Update Date | 2016-09-22 |