| NPI | 1366599185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2020010606) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 63355) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OK 35336) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2024-10-16 |