| NPI | 1023100310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME136894) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G87405) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-06-28 |