| NPI | 1104047083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 0069182) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 43864) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: WI 54986-20) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-12-21 |