| NPI | 1164423265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX S8332) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 29467) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-11-24 |