| NPI | 1063490191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 27965) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U4997) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX U4997) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2023-06-29 |