| NPI | 1265896039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: WA MD60864517) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60864517) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2025-09-29 |