| NPI | 1164538914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q2367) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME95971) |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX Q2367) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX Q2367) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2015-03-31 |