| NPI | 1952795577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: AL MD.42771) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2021-07-14 |