| NPI | 1821086554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 62463) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35084250) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2019-10-29 |