| NPI | 1649490228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: UT 5414413-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 5414413-1205) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2021-10-27 |