| NPI | 1407177652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: GA 069639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 4239) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2015-12-11 |