| NPI | 1316161128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M5961) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: TX M5961) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2024-01-03 |