| NPI | 1427518042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.153463) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.153463) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-10-06 |