| NPI | 1730155847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 031713) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 031713) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NY 157757) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2023-05-30 |