| NPI | 1902906159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX K7516) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX K7516) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-11-12 |