| NPI | 1679870125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MT182098) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD427332) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2021-11-30 |