| NPI | 1295060119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME141917) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT195624) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2019-08-02 |