| NPI | 1558797464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2020013076) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10046337) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2020-08-04 |