| NPI | 1053313171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 082114) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: OH 82114) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 082114) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2011-10-05 |