| NPI | 1093794653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NE 33480) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 43837) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2026-02-23 |