| NPI | 1649251836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO DR.0057028) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TX K1369) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2010020915) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2016-08-17 |