| NPI | 1093085821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MN 59919) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MD D0064836) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2015-12-10 |