| NPI | 1710077896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 29088) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL29088) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-11-04 |