| NPI | 1962575936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 028157) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 49938) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-03-13 |