| NPI | 1649584780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.126267) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A141239) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MO 2021046945) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CA A141239) | |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2021-12-02 |