| NPI | 1548461346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NV 19504) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA C54296) |
| 174400000X Specialist (Licence: CA c54296) | |
| 208600000X Surgery (Licence: CA C54296) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NM MD2016-0814) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-10-23 |