| NPI | 1942251368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: IA 37045) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: WI 42790) |
| 208600000X Surgery (Licence: IA 37045) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-11-26 |