| NPI | 1932668258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 60924) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME165859) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2025-07-21 |