| NPI | 1639360753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: VA 0101257440) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-232776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-02-23 |