| NPI | 1154391142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KY TP372) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60667533) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY 55798) | |
| 208600000X Surgery (Licence: MN 107809) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036-154839) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01039396A) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NH LT-4111) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-09-22 |