| NPI | 1447416466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX P9121) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2011016082) |
| 208600000X Surgery (Licence: TX P9121) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KS 04-35084) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2022-11-28 |