| NPI | 1326209735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: UT 9203042-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A112687) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2021-11-08 |