| NPI | 1023098621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 58024) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 58024) |
| 208600000X Surgery (Licence: MA 58024) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2013-02-07 |