| NPI | 1518961903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301045625) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35075613) |
| 208600000X Surgery (Licence: CA C51076) | |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35075613) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA C51076) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2013-11-15 |