| NPI | 1215199799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD457437) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD457437) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2024-08-15 |