| NPI | 1346300258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 35.088383) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 46573) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-10-13 |