| NPI | 1659588267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 35091757) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2011-00061) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2022-03-01 |