| NPI | 1063544922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 31185) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 216286) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-10-08 |