| NPI | 1215248711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME124350) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 4244) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2019-05-31 |