| NPI | 1629085675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MO 2006031060) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: KS 04-32152) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: KS 0432152) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2006031060) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2026-09-03 |