| NPI | 1730133836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: SC 51855) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: FL ME0057951) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-02-23 |