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 |