| NPI | 1265499206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2013-01542) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35060022S) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-12-06 |