| NPI | 1508096413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U6801) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 71283) |
| 208600000X Surgery (Licence: NM MD2019-0775) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: GA 71283) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2024-03-12 |