| NPI | 1053402487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: DC MD037351) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35-088664) |
| 208600000X Surgery (Licence: OH 35-088664) | |
| 208600000X Surgery (Licence: MD D94365) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-01-30 |