| NPI | 1992755540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35-095425) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 229244) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-05-25 |