| NPI | 1194850867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2015-0112) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 12677) |
| 208600000X Surgery (Licence: WA MD00027549) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: WA MD00027549) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2025-01-13 |