| NPI | 1700183282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.122004) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.122004) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2021-10-15 |