| NPI | 1679991665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.145489) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CO DR.0064773) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2022-09-23 |