| NPI | 1245489111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2012023812) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NH 20068) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2020-01-13 |