| NPI | 1871026302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME168833) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101265991) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2024-06-21 |