| NPI | 1619107349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MA 282195) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX P7281) |
| 207X00000X Orthopaedic Surgery (Licence: ME MD24224) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: TX P7281) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2021-02-05 |