| NPI | 1407502644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX 48047) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX 48550) |
| 208000000X Pediatrics (Licence: TX 48047) | |
| 208000000X Pediatrics (Licence: TX 48550) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX 48047) | |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2024-10-23 |