| NPI | 1336450840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.128405) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301106656) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2016-07-06 |