| NPI | 1598861247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 093575) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 028589) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-01-15 |