| NPI | 1689667677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 151449-1) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NY 151449-1) |
| 2086S0120X Surgery Pediatric Surgery (Licence: NY 151449-1) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2007-07-08 |