| NPI | 1124041827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 165684) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 165684) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-03-09 |