| NPI | 1104820554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX M3884) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 7025) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2010-11-09 |