| NPI | 1568432250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 33460) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 14220) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-09-08 |