| NPI | 1730127465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 145676-1) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 145676) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2015-12-11 |