| NPI | 1669754925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: RI MD16869) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD039738) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2020-02-05 |