| NPI | 1730165366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: ID M10261) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 9901473) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2014-02-18 |