| NPI | 1780778696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: DC MD19189) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G89406) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-11-07 |