| NPI | 1003221094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NY 316762) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA 473289) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2023-04-10 |