| NPI | 1710269261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD214949) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 84076) |
| Enumeration Date | 2011-09-11 |
| Last Update Date | 2023-07-06 |