| NPI | 1801871306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA9779600) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G41471) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2023-09-28 |