| NPI | 1649269473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME138640) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 31096) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: WI 31096) | |
| 207X00000X Orthopaedic Surgery (Licence: WI 31096) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2021-06-15 |