| NPI | 1760715601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MD D79611) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD435737) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2020-02-11 |