| NPI | 1629336086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MT215089) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME124635) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2018-07-30 |