| NPI | 1508824541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX T5193) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: TN 62468) |
| 2086S0120X Surgery Pediatric Surgery (Licence: TN 62468) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-03-14 |