| NPI | 1861855900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME150779) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: FL ME150779) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD N210029002065) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2021-08-18 |