| NPI | 1578611505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: HI 15138) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A80916) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-11-18 |