| NPI | 1609008762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: DC MD037895) |
| Additional Taxonomies | 2088P0231X (Licence: DC MD037895) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2009-08-21 |