| NPI | 1720425390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 262955) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 255779) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OK 35666) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2022-07-21 |