| NPI | 1952399008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME68725) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME68725) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-05-19 |