| NPI | 1104150804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0102207283) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102207283) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2025-08-21 |