| NPI | 1588752836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: CO DR.0054069) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: MS 20817) |
| 208600000X Surgery (Licence: PA MD0598906) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2019-10-10 |