| NPI | 1215050653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A78090) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 51148) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-09-09 |