| NPI | 1275735789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: KY 53095) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35085025) |
| 2086X0206X Surgery, Surgical Oncology (Licence: KY TP594) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-05-05 |