| NPI | 1306076294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: AZ 58274) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ R71657) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: UT 8927677-1205) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NM MD2015-0397) | |
| Enumeration Date | 2009-07-25 |
| Last Update Date | 2019-07-09 |