| NPI | 1972760593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MA 261895) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 11013468A) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2015-05-01 |