| NPI | 1053455444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61617432) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2012-01216) |
| 2086X0206X Surgery, Surgical Oncology (Licence: NC 2012-01216) | |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2024-12-13 |