| NPI | 1619090396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 56366) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD15396) |
| 225100000X Physical Therapist (Licence: VT 040-0003455) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2021-06-28 |