| 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 |