| NPI | 1588920722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: OH 35.145501) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME140536) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2022-08-08 |