| NPI | 1871565762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35-090195) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD053529L) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2011-06-30 |