| NPI | 1609136993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD454180) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD454180) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2025-11-20 |