| NPI | 1821196825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35060630) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35.060630) |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MT 50824) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-11-27 |