| NPI | 1811160971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: VA 0101262368) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2020-10-08 |