| NPI | 1700968963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 42014) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 120819) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2022-07-21 |