NPI | 1629143458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: LA 200989) |
Additional Taxonomies | 208600000X Surgery (Licence: LA 200989) |
Enumeration Date | 2006-11-21 |
Last Update Date | 2013-10-08 |