| NPI | 1780849372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX P7925) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME115054) |
| 207X00000X Orthopaedic Surgery (Licence: MN 51930) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-07-01 |