| NPI | 1861714222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 66580) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.127245) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35.127245) | |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2020-08-20 |