| NPI | 1619005469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-01721) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: AR E-7272) |
| 2086S0120X Surgery Pediatric Surgery (Licence: GA 069664) | |
| 208600000X Surgery (Licence: AR E-7272) | |
| 208600000X Surgery (Licence: GA 069664) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: NC 2024-01721) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2024-09-12 |