| NPI | 1578748646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX Q3902) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2007021213) |
| 208600000X Surgery (Licence: TX Q3902) | |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2024-08-13 |