| NPI | 1649619115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME146486) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A136519) |
| 2086X0206X Surgery, Surgical Oncology (Licence: FL ME146486) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2022-12-13 |