| NPI | 1124393467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2022029448) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD463196) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2022-09-07 |