| NPI | 1578762357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MN 41499) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 231559) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2024-02-20 |