| NPI | 1134321789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MN 59784) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 20A9899) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: GA 67028) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 0009898) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2020-08-27 |