| NPI | 1083608707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN MD13707) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD13707) |
| 208600000X Surgery (Licence: TN MD13707) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2015-02-11 |