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 |