NPI | 1972790384 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME107247) |
Additional Taxonomies | 208600000X Surgery (Licence: FL ME107247) |
2086S0120X Surgery, Pediatric Surgery (Licence: NC 2025-03064) | |
208600000X Surgery (Licence: NY 390200000X) | |
Enumeration Date | 2007-09-29 |
Last Update Date | 2025-09-09 |