| NPI | 1184808461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME128657) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME128657) |
| 208600000X Surgery (Licence: NY 244471) | |
| Enumeration Date | 2007-12-22 |
| Last Update Date | 2016-07-10 |