| NPI | 1174588990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: DE C10009160) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: PA MD437936) |
| 2086S0120X Surgery Pediatric Surgery (Licence: NJ MA08651400) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2018-05-21 |