| NPI | 1356533673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX Q6640) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116019432) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2021-04-22 |