| NPI | 1164661906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 269624) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MD D69271) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2019-03-13 |