NPI | 1871563445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME130124) |
Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 28108) |
207X00000X Orthopaedic Surgery (Licence: PA MD-423988) | |
Enumeration Date | 2006-01-25 |
Last Update Date | 2021-04-27 |