| NPI | 1558391623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX h6136) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX h6136) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-11-06 |