| NPI | 1518113315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301092803) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.132297) |
| 208600000X Surgery (Licence: MI 4301092803) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.132297) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2023-03-21 |