| NPI | 1306875570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 05522R) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 05522R) |
| 208C00000X Colon & Rectal Surgery (Licence: LA 0522R) | |
| 207P00000X Emergency Medicine (Licence: LA MD.05522R) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2014-09-16 |