| NPI | 1649483181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 283192) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2006015616) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2023-06-29 |