| NPI | 1457478646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD61649944) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61649944) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2025-04-29 |