| NPI | 1083794036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.065006) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 52167) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01081810A) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2019-03-04 |