| NPI | 1982638524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 11008) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PR 11008) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2017-05-07 |