| NPI | 1326206152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: RI MD18786) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 272789) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2025-11-25 |