| NPI | 1679739544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2009004526) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2009004526) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KS 04-33787) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KS 04-33787) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2026-01-07 |