| NPI | 1659576387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.097200) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35-097200) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2026-03-24 |