| NPI | 1215027883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX N3094) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AR N-8271) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-06-08 |