| NPI | 1518176510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: HI MD-18201) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116017804) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-10-20 |