| NPI | 1568737757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.130295) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.130295) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2019-11-13 |