| NPI | 1932199643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME97943) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 209462) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-03-07 |