| NPI | 1457765919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: UT 12229874-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206660) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2021-12-13 |