| NPI | 1225422470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 332430-01) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MT 143453) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: WI 76648-20) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-10-31 |