| NPI | 1760895536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: IA MD-48841) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-10019) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-11-13 |