| NPI | 1730317736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME124160) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI 14593) |
| 207X00000X Orthopaedic Surgery (Licence: MN 52941) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2018-09-28 |