| NPI | 1326284696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PR 18552) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 18552) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2019-06-18 |