| NPI | 1740413061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MT 44391) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.094201) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2024-06-06 |