| NPI | 1669590543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AZ 47558) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301088111) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 47558) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: UT 7947793-1205) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301088111) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: AZ 47558) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2018-03-23 |