| NPI | 1912164658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: FL ME104875) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D66848) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD D066848) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2021-09-13 |