| NPI | 1154340404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: SC 29155) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 29155) |
| 2086S0102X Surgery Surgical Critical Care (Licence: SC 29155) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-05-14 |