| NPI | 1619197555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301091753) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091753) |
| 208600000X Surgery (Licence: NJ 25MA08054700) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301091753) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.120317) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-09-06 |