| NPI | 1205199908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: PA MT220691) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125061643) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2020-06-25 |