| NPI | 1043868219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 306508) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WA MDRE.ML.60979056) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2022-12-29 |