| NPI | 1538728308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: PA OS024991) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58031898) |
| 207X00000X Orthopaedic Surgery (Licence: PA OT019232) | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2025-09-05 |