| NPI | 1982805289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NE 28145) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL16065) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2022-05-23 |