| NPI | 1376787366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WA MD60273378) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.011330) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2021-05-18 |