| NPI | 1790784221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: GA 28730) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: GA 028730) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2022-07-21 |