| NPI | 1407051220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX P7811) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.010886) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2020-11-20 |