| NPI | 1740364397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: NY 212487) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 212487) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2021-12-20 |