| NPI | 1124206230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TN MD40365) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: GA 054446) |
| 208600000X Surgery (Licence: TN MD40365) | |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2015-02-11 |