| NPI | 1972715654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD073623L) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD073623L) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: AL MD26451) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2021-07-21 |