| NPI | 1548271067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX T6739) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T6739) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME116067) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: LA 15258R) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2023-08-15 |