| NPI | 1306809918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX L2453) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: MT MED-PHYS-LIC-100462) |
| 2086S0120X Surgery Pediatric Surgery (Licence: OK 30540) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2021-09-08 |