| NPI | 1558518894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: ME MD21123) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 271028) |
| 208600000X Surgery (Licence: ME MD21123) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2025-03-24 |