| NPI | 1184873820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OK 28356) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY P56024) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2024-12-12 |