| NPI | 1356423859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.097012) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 13264) |
| 208600000X Surgery (Licence: OH 35.097012) | |
| 208C00000X Colon & Rectal Surgery (Licence: MN 53132) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2018-02-22 |