| NPI | 1497918957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VA 0101256920) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 242447) |
| Enumeration Date | 2008-07-04 |
| Last Update Date | 2014-10-02 |