| NPI | 1629075627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35-035616) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 17153) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2012-11-15 |