| NPI | 1992871412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 270597) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 511220) |
| 208600000X Surgery (Licence: MA 270597) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2019-06-17 |