| NPI | 1164983250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: LA 339037) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.145102) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: LA 339037) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-10-26 |