| NPI | 1003040353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: PA MD468823) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: CA A115198) |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX R3701) | |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2023-05-02 |