| NPI | 1497771141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 54706) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35-080813) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-01-29 |