| NPI | 1346453644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD451384) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 50054) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2015-08-14 |