| NPI | 1306967534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 266241) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 225637) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-06-12 |