| NPI | 1669697041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 280479) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301087758) |
| 208600000X Surgery (Licence: MD D82167) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2026-05-08 |