| NPI | 1811155450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: FL ME127463) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 47294) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN12168) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2020-10-07 |