| NPI | 1124215074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S3980) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A96280) |
| 208600000X Surgery (Licence: TX 46258) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX S3980) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2024-05-03 |