| NPI | 1184833519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD071825L) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA09193100) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-11-08 |