| NPI | 1801002415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35.089300) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.089300) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2016-08-10 |