| NPI | 1245734086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: CO DR.0070353) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA ML60886941) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2023-08-16 |