| NPI | 1225475155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.133330) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.133330) |
| 208600000X Surgery (Licence: CA A125015) | |
| 208600000X Surgery (Licence: MO 2017008628) | |
| Enumeration Date | 2013-06-01 |
| Last Update Date | 2020-05-14 |