NPI | 1083004949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A199720) |
Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 311485-01) |
Enumeration Date | 2015-01-30 |
Last Update Date | 2025-07-01 |