| NPI | 1699777474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: GA 67600) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 67600) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-04-06 |