| NPI | 1144213877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35-04-4135-L) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD026915E) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 01029305A) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2010-01-22 |