| NPI | 1700840469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: NC 2014-00192) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35075425d) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2014-06-20 |