| NPI | 1255785358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 95019) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 218749) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2025-11-18 |