| NPI | 1760644330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101266703) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101266703) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2019-09-13 |