| NPI | 1871579243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2023012380) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME56456) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME56456) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-05-21 |