| NPI | 1578533675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2010010720) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 46762) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-02-10 |