| NPI | 1659371326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MI 4301047728) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301047728) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2008-03-21 |