| NPI | 1083243984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: FL ME182221) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME182221) |
| 208600000X Surgery (Licence: WI 103213) | |
| 208600000X Surgery (Licence: MN 78993) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-08-19 |