| NPI | 1972790384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: FL ME107247) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 390200000X) |
| 208600000X Surgery (Licence: FL ME107247) | |
| Enumeration Date | 2007-09-29 |
| Last Update Date | 2018-05-08 |