| NPI | 1588717227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-00591) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 32436) |
| 208600000X Surgery (Licence: NY 270472) | |
| 208600000X Surgery (Licence: TX Q4861) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX Q4861) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-05-13 |