| NPI | 1225329972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: PA MD450957) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10140000) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT199065) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199065) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2021-11-19 |