| NPI | 1164427639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OH 35-047016) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-047016) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35-047016) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2025-09-11 |