| NPI | 1821126665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 49713) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A90688) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2013-09-03 |