| NPI | 1801836887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: MA 45671) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 45761) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-10-10 |