| NPI | 1053710228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OR MF226762) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD P30325) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2025-08-08 |