| NPI | 1992947634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60225397) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 390200000X) |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2021-03-05 |