| NPI | 1073650362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 48258) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NM MD2017-0745) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2017-12-11 |