| NPI | 1497731095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200501628) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NC 200501628) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NC 200501628) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2010-11-12 |