| NPI | 1760505481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NY 266292) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA AN-1992975-G-119) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: CA A115081) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-12-21 |