| NPI | 1689952574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-02014) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA LT000710) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2014-04-15 |