| NPI | 1992117006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA md474314) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206221) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2025-01-23 |