| NPI | 1487846267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD160290) |
| Additional Taxonomies | 208600000X Surgery (Licence: ZZ 41830) |
| 208600000X Surgery (Licence: WA 60316843) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: OR MD160290) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2025-05-29 |