| NPI | 1528023447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO 0056140) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: OH 35087432) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2017-05-15 |