| NPI | 1417307059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2018015583) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2018015583) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2026-08-13 |