| NPI | 1346234937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WV 25708) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 215665-1) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2022-04-15 |