| NPI | 1235176439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME138873) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 216139) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-02-16 |