| NPI | 1053738427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101277533) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 141329) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2023-09-20 |