| NPI | 1205934866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD22941) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A53689) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-02-04 |