| NPI | 1396023495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: FL ME141830) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A150331) |
| 208600000X Surgery (Licence: FL ME141830) | |
| 2086X0206X Surgery Surgical Oncology (Licence: CA A150331) | |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2019-09-16 |