| NPI | 1326143512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.140431) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME101048) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2025-11-11 |