| NPI | 1942364690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME159664) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U8988) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2010028270) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: WV 31977) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX U8988) | |
| 208600000X Surgery (Licence: MO 2010028270) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2024-04-01 |