| NPI | 1669683850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX S7580) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301084031) |
| Enumeration Date | 2007-05-27 |
| Last Update Date | 2020-08-20 |