| NPI | 1174697502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA11443500) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101277434) |
| 208600000X Surgery (Licence: TX T7790) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: NE 23626) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: VA 0101277434) | |
| 208600000X Surgery (Licence: VA 0101277434) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: NE 23626) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: NJ 25MA11443500) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: TX T7790) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: NJ 25MA11443500) | |
| 2086X0206X Surgery Surgical Oncology (Licence: NE 23626) | |
| 2086X0206X Surgery Surgical Oncology (Licence: NJ 25MA11443500) | |
| Enumeration Date | 2006-11-18 |
| Last Update Date | 2024-04-26 |