| NPI | 1629363551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2017-01599) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT200511) |
| 207X00000X Orthopaedic Surgery (Licence: NC 201701599) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200511) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2025-03-11 |