| NPI | 1154778652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD465796) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 125.077278) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT210517) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2022-08-24 |