| NPI | 1740576370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 274241) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 274241) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-10-28 |