| NPI | 1528217627 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA DO.000401) | 
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: LA 000401) | 
| Enumeration Date | 2008-09-12 | 
| Last Update Date | 2025-09-04 |