| NPI | 1407502644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX 48047) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 48047) |
| 2086S0120X Surgery Pediatric Surgery (Licence: TX 48047) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10077849) | |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2023-12-14 |