| NPI | 1417570516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 35.156563) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301512404) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2026-06-29 |