| NPI | 1982660874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 19494) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 19494) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2008-04-15 |