| NPI | 1790941391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AZ 52531) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 237400) |
| 208600000X Surgery (Licence: AZ 52531) | |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2022-02-08 |