| NPI | 1982773545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA08195900) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35062565A) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2015-11-03 |