| 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 |