| NPI | 1083093488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.152722) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: HI MD-21257) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2025-08-11 |