| NPI | 1780646828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: FL ME127453) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: TX M3327) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-07-13 |