| NPI | 1316231475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX P2538) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10033795) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2020-11-05 |