| NPI | 1831193416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD471525) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 34271) |
| 208600000X Surgery (Licence: IL 036131248) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01080013A) | |
| 208600000X Surgery (Licence: WI 47577) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2023-06-15 |