| NPI | 1861631244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 47536) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NM MD2017-0793) |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2019-12-10 |