| NPI | 1700902608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KS 04-23862) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM 20030056) |
| 208600000X Surgery (Licence: IL 036131963) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2016-11-22 |