| NPI | 1861532327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 43515) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R0465) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01065367A) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2010-07-13 |