| NPI | 1629607411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD493405) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12978100) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-08-03 |