| NPI | 1497963268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A121803) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082235) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2018-01-23 |