| NPI | 1366860140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD468207) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 93574) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2025-02-28 |