| NPI | 1871563445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: FL ME130124) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: FL ME130124) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-12-04 |