| NPI | 1568649549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A117302) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: CA A117302) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2020-10-14 |