| NPI | 1801982764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD152536) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 41464) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-24 |