| NPI | 1295726024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 27439) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 250878) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2023-02-08 |