| NPI | 1184808131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: MA 273115) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: CT 050615) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CT 050615) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 273115) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2017-10-26 |