| NPI | 1376751644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.092896) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35092896) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2012-11-14 |