| NPI | 1215956701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME153478) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 79209) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MA 79209) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-01-27 |