| NPI | 1205128030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: IL 036.140210) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199350) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT199350) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2016-06-22 |