| NPI | 1376839183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: KY C1453) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.013402) |
| 207X00000X Orthopaedic Surgery (Licence: CA 20A12449) | |
| 207X00000X Orthopaedic Surgery (Licence: OH 34.013402) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2023-06-26 |