| NPI | 1245687334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO DR.0076908) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R9194) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2026-10-01 |