| NPI | 1689634388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME120744) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 21963) |
| 2086X0206X Surgery, Surgical Oncology (Licence: WV 21963) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2014-08-19 |