| NPI | 1215431317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OK 9546) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 9546) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OK 9546) | |
| 208C00000X Colon & Rectal Surgery (Licence: OK 9546) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2026-07-28 |