| NPI | 1447552245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX Q1266) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT 190495) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2014-10-01 |