| NPI | 1497829337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 32972) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TX P8248) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: SC 36023) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2016-06-20 |