| NPI | 1447748157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V1005) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT018277) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018277) | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2024-05-20 |