| NPI | 1982630794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO DR.0052621) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 35077147) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-09-16 |