| NPI | 1356634166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2017-01061) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 267052) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MA 267052) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2022-05-13 |