| NPI | 1578765608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: NJ 25MA10291700) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP01137) |
| 2086S0120X Surgery Pediatric Surgery (Licence: NY 280080) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2024-08-30 |