| NPI | 1568728244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MA 266573) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ME MD24227) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-02-23 |