| NPI | 1114385440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA C133908) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.134003) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MO MD101895) | |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2022-03-21 |