| NPI | 1144547977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA 157673) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 157673) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2018-08-21 |