| NPI | 1063701746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: DC MD600004527) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT196539) |
| 2086X0206X Surgery, Surgical Oncology (Licence: GA 072670) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2025-11-08 |