| NPI | 1932395605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX N9789) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 200655) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2021-05-18 |