| NPI | 1326197625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301076130) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TX V6472) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: SD 17373) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2026-07-23 |