| NPI | 1518993369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: WI 64159) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 264261) |
| 208600000X Surgery (Licence: MN 50701) | |
| 208600000X Surgery (Licence: IA R-6997) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2022-02-01 |