| 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 |