| NPI | 1225076359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 13944824-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301083195) |
| 208000000X Pediatrics (Licence: TN 43020) | |
| 208000000X Pediatrics (Licence: MI 4301083195) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: MI 4301083195) | |
| 2080S0012X Pediatrics, Sleep Medicine (Licence: PA MD462484) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2024-10-10 |