| NPI | 1730170473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: VA 0101042925) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101042925) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-10-11 |