| NPI | 1164867370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: MT 78179) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: WA 60858528) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2025-04-09 |