| NPI | 1922070135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX P1016) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 223335) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CT 48734) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2011-09-23 |