| NPI | 1639458201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: AZ 58518) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: PA MT200160) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2019-08-09 |