| NPI | 1033313747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NH 14924) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 50003) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35.131752) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2022-07-21 |