| NPI | 1356874440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301512415) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 1356874440) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2024-08-22 |