| NPI | 1518057074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: DC MD33364) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: GA 041751) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2017-09-01 |