| NPI | 1679835219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: TX R1104) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5315055844) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301101089) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-07-21 |