| NPI | 1154540466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301090598) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301090598) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35086254) | |
| 208600000X Surgery (Licence: MI 4301090598) | |
| 208600000X Surgery (Licence: OH 35086254) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35086254) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2023-03-21 |