| NPI | 1932117462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G83234) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD23219) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-03-23 |