NPI | 1124019740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: MA 150801) |
Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 150801) |
Enumeration Date | 2005-11-02 |
Last Update Date | 2012-12-20 |