| NPI | 1083617369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H4422) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TX H4422) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2012-02-02 |