| NPI | 1649699398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO DR.0064712) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 65400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207X00000X Orthopaedic Surgery (Licence: FL ME139080) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-08-12 |