| NPI | 1780652354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 35.063989) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 50820) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WI 50820-020) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-09-28 |