| NPI | 1104263565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: MA 275087) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ME MD24228) |
| 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: NH 19947) | |
| Enumeration Date | 2013-05-25 |
| Last Update Date | 2021-02-03 |