| 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 |