| NPI | 1235146481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME129852) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 22268) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-03-29 |