| NPI | 1235365081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: MI 1235365081) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: TX U2104) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2023-03-14 |