| NPI | 1003945411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N5695) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A83296) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX N5695) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2012-02-03 |