| NPI | 1881668978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD.61671833) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD27491) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2025-07-14 |