| NPI | 1134327901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MN 50819) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 50819) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX Q9609) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2018-12-05 |