| NPI | 1932588829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OK 39908) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 390200000X) |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2022-07-11 |