| NPI | 1942299888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NM MD2016-0003) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0084182) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2017-01-17 |