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 |