| NPI | 1760742324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: PA MT201618) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT201618) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2022-07-21 |