| 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 |