| NPI | 1669975629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 05666) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY TP713) |
| 207X00000X Orthopaedic Surgery (Licence: PA 390200000X) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018504) | |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2024-09-20 |