| NPI | 1912326372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: TX V1758) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: TX V1758) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-06-22 |