NPI | 1346453644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD451384) |
Additional Taxonomies | 208600000X Surgery (Licence: MN 50054) |
2086S0120X Surgery, Pediatric Surgery (Licence: WI 103103) | |
Enumeration Date | 2007-05-07 |
Last Update Date | 2025-09-25 |