| NPI | 1225298870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA 112133) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A112133) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-12-23 |