| NPI | 1437110004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN MD60987) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MN 40928) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2024-03-06 |