| NPI | 1376519967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 60192) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD065816L) |
| 208600000X Surgery (Licence: TN 60192) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CA G87706) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-04-18 |