| NPI | 1972671287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 30918) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN8848) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2011-10-11 |