| NPI | 1497407530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX 48644) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35.145022) |
| 208600000X Surgery (Licence: TX 48263) | |
| 208600000X Surgery (Licence: TX 48644) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.145022) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX 48263) | |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2025-03-13 |