| NPI | 1407827793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35-125615) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: IN 01052143A) |
| 208600000X Surgery (Licence: WA MD00047574) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2016-10-13 |