| NPI | 1720106107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX K4257) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX K4257) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2016-02-12 |