| NPI | 1164765913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD471190) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-08445) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2021-04-07 |