| NPI | 1669868162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD489646) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 317390) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OK 41657) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2025-08-28 |