| NPI | 1649290321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: AR E-18184) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2023-02730) |
| 208600000X Surgery (Licence: AR E-18184) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: OH 35-080742) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-09-05 |