| NPI | 1861485591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35-03-6259-M) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD015942E) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2009-12-16 |