| NPI | 1205916632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.131998) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OK 30557) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: IN 01079052A) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX L2175) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-05-28 |