| NPI | 1447472196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: LA MD.206725) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX P4835) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-06-25 |