| NPI | 1205808490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 43768) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 41264) |
| 208600000X Surgery (Licence: MN 43768) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IA 41264) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-08-19 |