| NPI | 1821076019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD048614L) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TN MD38890) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-08-24 |