| NPI | 1508869751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35048384) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35-04-8384A) |
| 208600000X Surgery (Licence: OH 35048384) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2012-02-08 |