| NPI | 1295873297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NV 14201) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G81845) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2012-07-09 |