| NPI | 1205828407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX K9847) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: TX K9847) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2012-02-02 |