| NPI | 1114931029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AR E3246) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2000150873) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2009-12-03 |