| NPI | 1780735464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WV 18684) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35080502) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2022-09-19 |