| NPI | 1548619901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VT 042.0013594) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: ZZ 78174) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-09-08 |