| NPI | 1700045564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A100105) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35.099812) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2016-04-20 |