| NPI | 1710364088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MI 4301512801) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10054074) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2024-10-16 |