| NPI | 1568549574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: LA 309011) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 32198) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MN 32198) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-04-16 |