| NPI | 1538204748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME176343) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: SC 93808) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD483654) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NY 003893) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2026-01-19 |