| NPI | 1154697100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 281893) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA MD-46096) |
| 208600000X Surgery (Licence: NY 281893) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IA MD-46096) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2021-10-05 |