| NPI | 1619086436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX P1669) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20008281) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2012-09-26 |