| NPI | 1063726446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: PA OS018102) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS018102) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA (0116027757)) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116027757) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2021-02-15 |