| NPI | 1003436353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS021700) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2025-01641) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2026-08-06 |