| NPI | 1508814146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD068661L) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA07298100) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-02-07 |