| NPI | 1306139837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 60869) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT199473) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199473) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2020-08-19 |