| NPI | 1386607513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 072465) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD427683) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2016-08-23 |