| NPI | 1104913532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: FL ME 96070) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 96070) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2010-09-09 |