| NPI | 1952661217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 282275) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10090100) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD460159) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2022-07-21 |