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 |