| NPI | 1306867510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0059192) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD458638) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2026-02-17 |