| NPI | 1407010069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX P5988) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: WA MD 60221950) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2014-08-07 |