| NPI | 1063974319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT019071) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2021-03-23 |