| NPI | 1265414551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: MA 231313) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 231313) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MA 231313) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2009-08-11 |