| NPI | 1487690889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101271609) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 23815) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036-131051) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: WA 60295888) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD160235) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-09-23 |