| NPI | 1912900036 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35079519) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35079519) |
| 208C00000X Colon & Rectal Surgery (Licence: OH 35079519K) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2023-11-03 |