| NPI | 1063701498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 297239) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 297239) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2025-12-08 |