| NPI | 1780637611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 200100863) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200100863) |
| 208600000X Surgery (Licence: MI 4301090987) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301090987) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-10-30 |