| NPI | 1720515968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.140717) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MD D86049) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2021-09-10 |