| NPI | 1154597011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SD 11615) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2012024116) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2020-02-10 |