| NPI | 1841257912 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: CA G26763)  | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: CA G26763)  | 
| 2086S0120X Surgery, Pediatric Surgery (Licence: CA G26763)  | |
| 2086X0206X Surgery, Surgical Oncology (Licence: CA G26763)  | |
| Enumeration Date | 2006-05-01 | 
| Last Update Date | 2008-07-30 |