| NPI | 1689054553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MO 2020013859) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2020013859) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2020-09-02 |