| NPI | 1982982872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX P0681) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX P0681) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2022-04-25 |