| NPI | 1851701437 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 83899) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| 207X00000X Orthopaedic Surgery (Licence: PA MD466843) | |
| Enumeration Date | 2014-05-05 | 
| Last Update Date | 2021-02-04 |