| NPI | 1053767954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: PA MT222150) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 266968) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2021-07-15 |