| NPI | 1942476692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: NC 2011-01098) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2009023874) |
| 208600000X Surgery (Licence: KS 0433069) | |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2014-11-25 |