| NPI | 1891849691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: GA 060223) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 02002729A) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2013-10-03 |