| NPI | 1609131754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME153957) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL MD.35857) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2022-03-16 |