| NPI | 1255508107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NC 2012-01027) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.013619) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2012-07-13 |