| NPI | 1316360621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: IA MD-55430) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD61427686) |
| 208600000X Surgery (Licence: IA MD-55430) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2025-11-12 |