| NPI | 1407890510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60183442) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 11841) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2017-03-28 |