| NPI | 1245387125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 39975) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD39975) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2017-04-06 |