| NPI | 1053807388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 13830) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AL L.5391F) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2021-08-04 |