| NPI | 1790880755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA10025200) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10025200) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.081904) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-04-15 |