| NPI | 1528024890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.134556) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: WV 30411) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY 37914) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2023-10-11 |