| NPI | 1306953989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35086376) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.086376) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2015-06-30 |