| NPI | 1790719235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: OH 34005069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.005069) |
| 207X00000X Orthopaedic Surgery (Licence: OH 34005069) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-01-19 |