| NPI | 1477633733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35069041) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TX L5362) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2007-01371) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2010-04-28 |