NPI | 1689672032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: LA MD.018087) |
Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: LA 018087) |
Enumeration Date | 2005-07-11 |
Last Update Date | 2021-06-21 |