| NPI | 1285736512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301082691) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082691) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.083885) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2022-09-06 |