| NPI | 1508065319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A71180) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00048270) |
| 208600000X Surgery (Licence: WA MD00048270) | |
| 208600000X Surgery (Licence: PA md425567) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA md425567) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD00048270) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: PA md425567) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2022-02-04 |