| NPI | 1548634330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: UT 14213758-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351045178) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2025-06-13 |