| NPI | 1083749170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 9401121) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 94-01121) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2016-09-26 |