| NPI | 1316785496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MA 1020626) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1020626) |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2024-12-04 |