| NPI | 1598184475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A168004) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME143651) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101266844) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2021-06-03 |