| NPI | 1265411979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX U5819) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U5819) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CA 92264) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-01-07 |