| NPI | 1962417600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME113029) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 167874) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NY 167874) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NJ 25MA08677000) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036125891) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2024-09-19 |