| NPI | 1093962581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: VA 0101255226) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NM MD2007-0633) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2013-12-30 |