| NPI | 1407171226 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL OS14498) | 
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MO 2024028589) | 
| Enumeration Date | 2010-04-05 | 
| Last Update Date | 2025-06-25 |