| NPI | 1952542169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A156443) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A156443) |
| 208600000X Surgery (Licence: MI 4301092787) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA A156443) | |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2023-06-19 |