| NPI | 1164451597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MA 151662) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 151662) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MA 151662) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-05-07 |