| NPI | 1811275407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101265162) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101265162) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2022-05-27 |