| NPI | 1982643979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TX L5508) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 78069) |
| 2088P0231X (Licence: TX L5508) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2011-09-28 |