| NPI | 1063807550 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: ME MD29704) | 
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD29704) | 
| 208600000X Surgery (Licence: TX R9093) | |
| Enumeration Date | 2015-04-01 | 
| Last Update Date | 2025-09-05 |