| NPI | 1063634038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX N7856) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: IA 37134) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-04-22 |