| NPI | 1356551782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: TX P3051) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD439130) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-02-04 |