| NPI | 1558619213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 57019) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WI 57621) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2018-08-08 |