| NPI | 1093809329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN DO1571) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA 20A4992) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CO 31753) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-07-31 |