| NPI | 1699937219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 39852) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019711) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD453016) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-06-25 |