| NPI | 1043484462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 32521) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.154575) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2025-11-24 |