| NPI | 1073777934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A84875) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MT MED-PHYS-LIC-115562) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036121352) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2022-09-13 |