| NPI | 1851718456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA LT000802) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 57.251899) |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2022-02-23 |