| NPI | 1376725101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME129728) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036078239) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2017-03-03 |