| NPI | 1174956817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX V7122) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: IA R-9836) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2025-07-16 |