| NPI | 1710243266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: WI 75653) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 75653) |
| 208600000X Surgery (Licence: IL 125062354) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2021-07-29 |