| NPI | 1184966483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A161848) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: CA A161848) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MT215236) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2019-08-14 |