| NPI | 1891010864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA C151171) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA C151171) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MA 244708) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD433284) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2024-04-29 |