| NPI | 1104086727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.126351) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: GA 69633) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-01-06 |