| NPI | 1205291333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD491213) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA 30054243) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2026-06-02 |