| NPI | 1184648784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ME 2163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-8598) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-10-07 |