| NPI | 1720167927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 198372) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2086S0120X) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-11-22 |