| NPI | 1811013840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD171728) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MT MED-PHYS-LIC-66859) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OR FE161796) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IA MD42623) | |
| 208600000X Surgery (Licence: MO 2007016896) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2022-07-11 |