| NPI | 1508862483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35042503) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35042503S) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2020-04-12 |