| NPI | 1073962460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: IA MD-57164) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 267006) |
| 2086X0206X Surgery, Surgical Oncology (Licence: IA MD-57164) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2026-10-07 |