| NPI | 1619295698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.148945) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD448907) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2023-08-07 |