| NPI | 1700849924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO DR-45824) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NM MD2017-0880) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CO 45824) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2019-12-20 |