| NPI | 1841504271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: WA MD60765286) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60765286) |
| 208600000X Surgery (Licence: NY 257955-1) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2019-01-08 |