| NPI | 1932291788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: DE C10005900) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: DE C10005900) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MD060167L) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: NJ MA07075000) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-05-15 |