| NPI | 1104067552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: TX R0731) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301092962) |
| 208600000X Surgery (Licence: TX R0731) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2022-04-21 |