| NPI | 1801155908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME161311) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 209374) |
| 363A00000X Physician Assistant (Licence: FL 9105977) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2024-06-27 |