| NPI | 1578797486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: FL 146820) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: NY 286738) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2020-08-21 |