| NPI | 1265876452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: TX Q9334) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 274929) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2021-04-13 |