| NPI | 1124032115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX H3828) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H3828) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2016-05-13 |