| NPI | 1124120290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2010-00640) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD429509) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY TP683) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2022-04-05 |