| NPI | 1801051255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 34.009978) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MO 2014010407) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2015-12-17 |