| NPI | 1982653382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MO R3N51) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: KS 04-25273) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-06-13 |