| NPI | 1013991009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G76785) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G76785) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2020-12-16 |