| NPI | 1659590990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.097364) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.097364) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY TP121) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2019-04-03 |