| NPI | 1043239536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 42482) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 42482) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MA 42482) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-04-20 |