| NPI | 1689657025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301050530) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35121952) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2025-04-09 |