| NPI | 1326098419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 55776) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD483873) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-02-05 |