| NPI | 1588763734 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TN 10156)  | 
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: TN MD 0000010156)  | 
| Enumeration Date | 2006-09-22 | 
| Last Update Date | 2010-06-15 |