| NPI | 1265405179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: FL ME107895) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME107895) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2024-07-31 |