| NPI | 1740292663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.091348) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.091348) |
| 208600000X Surgery (Licence: CA C50457) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: CA C50457) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2011-12-16 |