| NPI | 1629063722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: GA 2086S0120X) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 9500178) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.092404) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101277715) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2025-04-14 |