| NPI | 1184018046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A203910) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: CA A203910) |
| 208600000X Surgery (Licence: PA MT208201) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-10-20 |