| NPI | 1679836803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-00927) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 57364) |
| 208600000X Surgery (Licence: IN 01086262A) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01086262A) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2022-04-20 |