| NPI | 1053639302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD449085) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT197091) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197091) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2016-08-10 |