| NPI | 1164641759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: OH 35095235) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200500161) |
| 2086X0206X Surgery Surgical Oncology (Licence: FL TRN13554) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2021-02-12 |