| NPI | 1790912525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AZ 65757) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME133035) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-07-06 |