| NPI | 1245522077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 66486) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 66486) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199358) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2020-09-14 |