| NPI | 1093892689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: WA MD60021591) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A95149) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-03-15 |