| NPI | 1316931850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U6888) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD419867) |
| 208600000X Surgery (Licence: NY 204884) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX U6888) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD419867) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101270020) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2023-10-31 |