| NPI | 1407844301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 35211) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 35211) |
| 208600000X Surgery (Licence: AL 11154) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CO 35211) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AL 11154) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: AL 11154) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2012-07-18 |