| NPI | 1033557632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: AZ 69170) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD455530) |
| 208600000X Surgery (Licence: PA MT204054) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2023-09-26 |