| NPI | 1356646590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A157157) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2014-01197) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2026-09-18 |