| NPI | 1134864564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV SL1993) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 58.032971) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2023-06-19 |