| NPI | 1639451214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA11368200) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 336.105376) |
| 207X00000X Orthopaedic Surgery (Licence: AL MD.35247) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2023-06-26 |