| NPI | 1962897538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 55292) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01097417A) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2025-09-04 |