| NPI | 1598259152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: ND 24497) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: UT 14207040-1204) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2026-07-24 |