| NPI | 1790760577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA09265400) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME103692) |
| 208600000X Surgery (Licence: NJ 25MA09265400) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME103692) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-09-07 |