| NPI | 1225484678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A182373) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: CA A182373) |
| 208000000X Pediatrics (Licence: AZ 60889) | |
| 208000000X Pediatrics (Licence: CA A182373) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: CA A182373) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 60889) | |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: AZ 60889) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2024-05-06 |