| NPI | 1922290618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NH 15876) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 246489) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN8053) | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2012-12-05 |