| NPI | 1548381890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A105639) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A105639) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX U5648) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-12-07 |