| NPI | 1740355619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 31638) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN6863) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: AL 31638) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: AL L3337SP) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-03-05 |