| NPI | 1285658419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: NJ 25MA09507600) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: PA MD066546L) |
| 2086S0120X Surgery Pediatric Surgery (Licence: NY 240910) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-01-31 |