| NPI | 1396734570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 59597) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 59597) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-08 |