| NPI | 1811693138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 320031) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 320031) |
| 2086X0206X Surgery, Surgical Oncology (Licence: NY 320031) | |
| 208D00000X General Practice (Licence: NY 320031-01) | |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2025-12-08 |