| NPI | 1770928590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 15595) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME135225) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63297) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2023-12-20 |