| NPI | 1164412094 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: OH 35.084414) | 
| Additional Taxonomies | 208600000X Surgery (Licence: OH 36084412) | 
| Enumeration Date | 2005-10-22 | 
| Last Update Date | 2024-09-26 |