| NPI | 1295711323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 74011) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 74011) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2013-01-03 |