| NPI | 1669525473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 2086S0120X) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT184318) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2013-07-05 |