NPI | 1114157419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: PA MT197442) |
Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MT197442) |
2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA10642700) | |
Enumeration Date | 2009-07-21 |
Last Update Date | 2019-11-06 |