| NPI | 1295726024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CO 27439) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.154789) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NY 250878) | |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2026-03-17 |