| NPI | 1720297849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35-089504) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: ME 017790) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-03-10 |