| NPI | 1407167695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO DR.0062681) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010019175) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2024-08-09 |