| NPI | 1801917877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 31423) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 57404) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036129620) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2019-01-15 |