| NPI | 1104205996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: GA 101130) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018168A) |
| 2086X0206X Surgery, Surgical Oncology (Licence: NC 202201356) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-08-01 |