| NPI | 1770532996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL me83890) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 13964) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2024-06-27 |