| NPI | 1417361924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MD D93889) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD459462) |
| 208600000X Surgery (Licence: MD D93889) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: FL TRN24429) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2023-03-31 |