| NPI | 1437242252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA G89130) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 150347) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-04-02 |