| NPI | 1538319959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A123051) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091842) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2017-03-08 |