| NPI | 1457390528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 89583) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 93687) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-03-05 |