| NPI | 1124175013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MS 20556) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OK 32773) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-04-27 |