| NPI | 1003865031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036-111156) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 243656) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35091414) | |
| 208000000X Pediatrics (Licence: OH 35091414) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2011-09-20 |