| NPI | 1366410086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: CA A90439) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A90439) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2015-01-06 |