| NPI | 1689644965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME155630) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 62451) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OK 37284) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2020042538) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2025-06-06 |