| NPI | 1215164025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 54426) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 54426) |
| 208600000X Surgery (Licence: IL 125055836) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KY 54426) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: AL 35124) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY TP321) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2021-01-07 |