| NPI | 1801855408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60132177) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301070690) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2010-03-09 |