| NPI | 1194882175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: CO 50786) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: OH 35.083881) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2022-11-14 |