| NPI | 1053409698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: VT 042.0018422) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: GA 045676) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.139193) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-06-03 |