| NPI | 1154371151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-00332) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NC 2015-00332) |
| 2086S0120X Surgery Pediatric Surgery (Licence: NC 2015-00332) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-07-15 |