| NPI | 1245763242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: SC 97353) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NY 307823) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2026-06-22 |