| NPI | 1912147745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 324136) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OS015657) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MB09554300) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT012520) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2023-10-23 |