| NPI | 1548250319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: VA 0101240573) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MD D0061324) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2021-07-19 |