| NPI | 1902878176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME133357) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101051578) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-07-21 |