| NPI | 1831410349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: OR MD205228) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2014003107) |
| 208600000X Surgery (Licence: IA 8912) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: TX R7908) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2021-08-14 |