| NPI | 1053577742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME134648) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: ID M-15720) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2022-10-11 |