| NPI | 1851307615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME145876) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: WV 21001) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35.095858) | |
| 208600000X Surgery (Licence: OH 35.095858) | |
| 208600000X Surgery (Licence: WV 21001) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.095858) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WV 21001) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-12-02 |