| NPI | 1821037516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NM MD2008-0588) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI MD12068) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-11-29 |