| NPI | 1639151053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35083205) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MA 215360) |
| Enumeration Date | 2005-11-20 |
| Last Update Date | 2021-12-22 |