| NPI | 1790784379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: GA 50252) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME160141) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2026-06-03 |