| 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 |