| NPI | 1578756078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 58.001763) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 34.009272) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2013-09-04 |