| NPI | 1336163328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: CA G61190) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G61190) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-03-31 |