| NPI | 1487655049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 34600) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: IA 34600) |
| 208600000X Surgery (Licence: MT MED-PHYS-LIC-12087) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MT MED-PHYS-LIC-12087) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MT MED-PHYS-LIC-12087) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IA 34600) | |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2024-05-20 |