| NPI | 1609818061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 45565) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MN 45565) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2012-08-09 |