| NPI | 1114447182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS019604) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT017682) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017682) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-11-05 |