| NPI | 1689937385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: LA 330558) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME145895) |
| 208600000X Surgery (Licence: MA L-252944) | |
| 208600000X Surgery (Licence: LA 330558) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2022-08-30 |