| NPI | 1538365002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A105968) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A105968) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2016-07-09 |