| 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 |