| NPI | 1235593625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: UT 13296068-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 62635) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2024-01-10 |