| NPI | 1205931458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 28576) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 222161) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2008-06-26 |