| NPI | 1154307858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.077358) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301102844) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2026-04-16 |