| NPI | 1639431802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A146581) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 310072) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: LA 310072) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2025-09-04 |