| NPI | 1457528028 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NE 28765) | 
| Additional Taxonomies | 208600000X Surgery (Licence: NC 128755) | 
| Enumeration Date | 2008-05-13 | 
| Last Update Date | 2015-09-21 |