| NPI | 1104838275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: FL ME117351) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.085853) |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX N6714) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2015-10-22 |