| NPI | 1013164219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX P5820) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60020733) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2013-10-28 |