| NPI | 1639205214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 35.136731) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 231110) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-11-30 |