| NPI | 1104084441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NY 255774) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: PA MD456303) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2020-09-21 |