| NPI | 1235425034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT199968) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD452138) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-04-16 |