| NPI | 1265503189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NY 1907421) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: CT 036159) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NY 1907421) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-12-21 |