| NPI | 1184755407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D35110) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MD D35110) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-11-06 |