| NPI | 1336144815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-056424) |
| Additional Taxonomies | 2086S0129X (Licence: OH 35-056424) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35-056424) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2025-09-11 |