| NPI | 1649390378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MN 54989) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2009019569) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2012-11-01 |