| NPI | 1164876918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: UT 12793565-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A151041) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2022-10-19 |