| NPI | 1710071303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 13904) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WV 13904) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |