| NPI | 1922105303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WV MS01001) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2008004920) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-01-12 |