| NPI | 1811091424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MO 106695) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: VT 042-0015839) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2022-08-02 |