| NPI | 1689672172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: LA MD.021642) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: LA 021642) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2013-06-26 |