| NPI | 1902244197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME145467) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX bp10046909) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2022-07-29 |