| NPI | 1013019330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MI 4301080993) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301080993) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2012-05-31 |