| NPI | 1356632939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60661651) |
| Additional Taxonomies | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: WA MD61089899) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2021-08-26 |