| NPI | 1538204748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD483654) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 003893) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-01-24 |