| NPI | 1609211507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: AZ 64230) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 192325) |
| 208600000X Surgery (Licence: UT 192325) | |
| 208600000X Surgery (Licence: CA A159507) | |
| 2086X0206X Surgery Surgical Oncology (Licence: CA A159507) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-11-11 |