| NPI | 1801159520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO DR.0073444) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0073444) |
| 208600000X Surgery (Licence: CA A127524) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2025-02-10 |