| NPI | 1760640692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.092167) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 52205) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: KY 47884) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2025-09-10 |