| NPI | 1508065046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD61090045) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 275811) |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2023-11-30 |