| NPI | 1154419471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MDO39201E) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD039201E) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2017-03-09 |