| NPI | 1972568681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G135070) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 40959) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: AZ 44629) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2024-04-29 |