| NPI | 1962666776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VT 032.0107331) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA ot012567) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2014-11-07 |