| NPI | 1295777514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME139178) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35086986) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-09-01 |