| NPI | 1912357427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301109532) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301514947) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2025-10-06 |