| NPI | 1780637231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AZ 24698) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WI 57614) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2018-03-26 |