| NPI | 1265516322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AZ 46508) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2005-00057) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-04-28 |