NPI | 1659535946 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NC 2017-01518) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY R1604) |
207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: GA 69645) | |
Enumeration Date | 2008-07-15 |
Last Update Date | 2021-05-11 |