| NPI | 1578873758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: FL ME141501) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: CA 146523) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2021-09-16 |