| NPI | 1245449743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301082482) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N2610) |
| 2086X0206X Surgery, Surgical Oncology (Licence: MI 055750) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2023-11-21 |