NPI | 1841504271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: WA MD60765286) |
Additional Taxonomies | 208600000X Surgery (Licence: WA MD60765286) |
208600000X Surgery (Licence: NY 257955-1) | |
Enumeration Date | 2010-07-27 |
Last Update Date | 2019-01-08 |