| NPI | 1396701264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 15501) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: WV 15501) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KY 35969) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: WV 15501) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY 35969) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2021-12-01 |