| NPI | 1518997394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 25007003905) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 226595) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-02-17 |