| NPI | 1003816539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 3508977K) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301038107) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301038107) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2012-05-01 |