| NPI | 1356630065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 63795) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.140112) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-12-27 |