| NPI | 1003264854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 1022723) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 1022723) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2025-12-18 |