| NPI | 1891053492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-01383) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2021-01383) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2021-01383) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2025-09-25 |