| NPI | 1750558508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 212781) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: RI MD12711) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2020-11-18 |