| NPI | 1568656957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD428905) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI MD428905) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2022-03-28 |