| NPI | 1528359783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.130109) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35130109) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2021-01-08 |