NPI | 1063504801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: DE C10007408) |
Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME126410) |
208600000X Surgery (Licence: FL ME126410) | |
2086S0120X Surgery, Pediatric Surgery (Licence: PA MD056010L) | |
Enumeration Date | 2006-09-29 |
Last Update Date | 2016-07-13 |