| NPI | 1255575122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R3572) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: NY 60-262191) |
| 2086S0120X Surgery Pediatric Surgery (Licence: TX R3572) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: GA 062071) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2022-07-21 |