| NPI | 1568788222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 88813) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 68455) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2023-08-17 |