| NPI | 1497971790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301084844) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA a70300) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-03-08 |