| NPI | 1467466961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101225774) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2014-02561) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2023-12-18 |